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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 822 - 12th August Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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40 years old female, Mid-Back


Case posted by Dr. Mark Hurt.


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Guest Maria George

Posted

Nevus Spilus (lentigine +compound nevus) containing ballon cell nevus.Nice case.
There lentiginous proliferation of melanocyte in the basal layer in addition to a compound nevus which shows clear cell features.So Nevus spilus.

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Arti Bakshi

Posted

Symmetrical compound melanocytic proliferation with clear/balloon cell change of intradermal component.
Good maturation, no dermal mitoses and no epidermal consumption.
Agree with 'Balloon cell naevus'.

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Robledo F. Rocha

Posted

I go with balloon cell melanoma. Even though maturation can be discerned with both HE and melan-A, there are some alarming findings like mitotic activity in the deeper reaches, some nested cells persisting in the deeper reaches surrounded by diffuse cells, and some pleomorphic cells scattered throughout the lesion.

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Sasi Attili

Posted

I think this is a benign Balloon Cell Nevus....

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Mark A. Hurt MD

Posted

My diagnosis was balloon cell melanocytic nevus.

It's in the pattern of a superficial congenital melanocytic nevus, but it has prominent balloon cells in the dermis. Under the scope, in contrast with the photographs, there were no mitotic figures that I could identify readily; some of those darker nuclei aren't mitotic figures. I believe this lesion is symmetrical, and it has uniform maturation throughout. I think that the Melan-A sains uniformly throughout the lesion, and Ki-67 has a low index. I will grant the possibility that such a lesion could be part of a nevus spilus, although there was no history of one clinically.

What does anyone make of the retia? Note the sparing of the suprapapillary plates. I see this phenomenon constantly in congenital melanocytic nevi and especially in lentiginous melanocytic nevi.

In my experience, I see balloon cell melanocytes most commonly in congenital melanocytic nevi; in many examples, they are multinucleated and contain eosinophilic globules. I did not see that here. It is uncommon, in my experience, to see so many balloon cells in a melanocytic nevus. What is your experience?

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Guest Jim Davie MD

Posted

Regarding my experiences with balloon cell change, I associate it most frequently in nevi (both acquired and congenital) that have other senescent features. In this case, the senescent atypia in the balloon-cell nuclei (smudgy nuclear hyperchromasia and enlargement, large nuclear pseudoinclusions, rare multinucleation) seem more prominent in the upper dermal component, which also shows the greatest balloon cell changes.

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